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Small ductal components influence management and preclude active surveillance. This study analyzed oncologic outcomes and therapeutic patterns in a multicenter German cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective multicenter cohort, seven high-volume German centers. 82 patients with histologically confirmed PDA diagnosed 2014\u20132024 included. Histopathological data from biopsy and radical prostatectomy (RP) specimens. Clinical data: local\/systemic treatments, follow-up until 2025. Primary outcome: time to systemic therapy. Secondary: overall survival. Predictors of adverse outcomes assessed via Cox regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Most patients presented with d\u2019Amico high-risk (47\/82, 57.3%) or intermediate-risk (28\/82, 34.2%) disease; 9.8% (8\/82) had synchronous metastases. RP performed in 82.9% (68\/82), radiotherapy in 7.3% (6\/82). Postoperative lymph node positivity and positive surgical margins occurred in 25.0% (17\/68) and 22.1% (15\/68), respectively. Median follow-up was 36 months (IQR 20\u201354 months). At the time of analysis, overall survival and cancer-specific survival were immature, with a limited number of events during follow-up. Among patients who required systemic therapy during follow-up, the median interval from local treatment to initiation of systemic therapy was 23 months (IQR 5\u201331 months). High pre-\/postoperative Gleason scores (\u2265\u20098) were associated with earlier initiation of systemic therapy. Among patients receiving systemic treatment (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924), ADT monotherapy showed longer median duration (27.2 months) than ARPI (10.9 months) or chemotherapy (6.1 months). Limitations: retrospective design, limited sample size.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PDA demonstrates aggressive behavior with early need for systemic therapeutic escalation in a substantial proportion. High Gleason scores were associated with earlier initiation of systemic therapy. These findings suggest that PDA should be considered a high-risk entity. However, survival outcomes require longer follow-up for definitive conclusions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00345-026-06686-6","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T09:13:13Z","timestamp":1787389993000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical characteristics, treatment patterns, and survival outcomes in ductal prostate cancer: a multicenter retrospective analysis"],"prefix":"10.1007","volume":"44","author":[{"given":"A.","family":"Handke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Paffenholz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Schlack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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Seifert, K. E.: reports grants or contracts from the German Society of Urology; payment or honoraria from and participation on a data safety monitoring board or advisory board for IPSEN, Johnson & Johnson, MSD, and Novartis; travel support from IPSEN. Linxweiler, J.: none Mink, J.: none Flockerzi, F.: none Nestler, T.: none Wenzel, M.: receives speaker honoraria from or is a consultant for Accord, Johnson & Johnson, Pfizer, MSD, AstraZeneca, and Ipsen. Siech, C.: none Darr, C.: Personal Fees: Janssen-Cilag, Ipsen; Travel Fees: Janssen-Cilag, Ipsen, Bayer. S. Foller: Honoraria: Astellas, AstraZeneca, Bristol-Myers Squibb, Ipsen Pharma, Merck, MSD, Pfizer; Consulting\/Advisory: AstraZeneca, Bristol-Myers Squibb, Merck, MSD, Pfizer, Roche. Gr\u00fcnwald, V.: honorarium for lecture: Bristol-Myers Squibb, Ipsen, Eisai, MSD, Merck KGa, AstraZeneca, AAA\/Novartis, Amgen, Johnson & Johnson, Teilx Pharmaceuticals, Gilead Sciences, Roche. Advisory board: Bristol-Myers Squibb, Pfizer, Novartis, MSD, Ipsen, Johnson & Johnson, Eisai, Debiopharm, Gilead Sciences, Oncorena, Synthekine, Recordati. Travel support: Pfizer, Johnson & Johnson, Merck KGa, Ipsen, Amgen. Roghmann, F.: Speaker honoraria, travel expenses: Johnson & Johnson, Roche, Merck, MSD, Pfizer, AstraZeneca, QED; Advisory Board: Johnson & Johnson, Roche, Merck, QED Tully, K.H.: Speaker honoraria: Johnson & Johnson, Roche, MSD, AstraZeneca; Travel support: Bayer, Johnson & Johnson; Advisory Board: Johnson & Johnson","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the institutional ethics committee of the leading center (Approval number: 2025-163-f-S) and was conducted in accordance with the Declaration of Helsinki and relevant local regulations. 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